Specialty medical injectable drug program, requirements and drug policy updates for March
New specialty medical injectable updates and requirements announced March 2024.
Review the following tables to determine changes to our specialty medical injectable drug programs.
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO REVIEW AT LAUNCH
For UnitedHealthcare Commercial business
| Drug Name | Treatment Uses |
| Rivfloza™ (nedosiran sodium) |
Used to lower urinary oxalate levels in children 9 and older and adults with primary hyperoxaluria type 1 and relatively preserved kidney function. |
Review the UnitedHealthcare Commercial Plan Review at Launch Medication List.
For questions, please contact your broker or UnitedHealthcare representative.
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR OUTPATIENT HOSPITAL PROVIDERS ONLY
For UnitedHealthcare Commercial business
| Drug Name | Effective Date | Therapeutic Class | HCPCS Code(s) | Specialty Pharmacy |
Adzynma |
4/1/24 | Enzyme Replacement Therapy | J3490 J3590 C9399 |
Orsini Pharmaceutical Services |
Review the UnitedHealthcare Commercial Plan Medication Sourcing List.
For questions, please contact your broker or UnitedHealthcare representative.
UPDATES TO DRUG PROGRAM REQUIREMENTS AND DRUG POLICIES
For UnitedHealthcare commercial business effective April 1, 2024
| Drug Name | Treatment Uses | Summary of Changes |
| Omvoh™ - IV formulation (mirikizumab-mrkz) |
Used for the treatment of moderately to severely active ulcerative colitis in adults. |
Add prior authorization/ notification Add to Site of Care Add as non-preferred product – must try and fail two of the following prior to coverage for Omvoh IV: Simponi®, Stelara®, Xeljanz®, Rinvoq® |
Upon prior authorization renewal, the updated policy will apply. UnitedHealthcare will honor all approved prior authorizations on file until the end date on the authorization or the date the member’s eligibility changes. Providers don’t need to submit a new notification/prior authorization request for members who already have an authorization for these medications on the effective date noted above.
For questions, please contact your broker or UnitedHealthcare representative.
